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Death review process identifies flaws in the system

By JIM ROSS, Times Staff Writer
© St. Petersburg Times
published July 7, 2002

LECANTO -- The Citrus County Fetal and Infant Mortality Review Committee has a difficult but necessary job: It examines sad cases and tries to learn something that might help prevent a similar tragedy.

The committee meets when it has two or more cases to review. During the past year, it studied only cases where babies died in utero (after 19 weeks) or shortly after birth; in the future, it will take cases of children up to age 1.

Rosemary Kipp, a Citrus County Health Department employee, serves as the committee's abstractor, or researcher. She receives copies of death certificates and then contacts the mother's health care providers and the hospital where she received care.

By law, committee abstractors statewide have access to mothers' medical files. The committee's records are not subject to subpoena, nor are they considered public records that the press or public can review.

In addition to reviewing the paperwork, Kipp also seeks an interview with the mother. She said most mothers consent, and also consent to her reviewing their records.

Kipp summarizes that information in a report, removing the names to protect the mother's identity. Kipp is the only committee member who knows the names of the people involved.

Committee members are health care providers from hospitals, medical offices, the Medical Examiner's Office and other similar places. They discuss the report and look for lessons the local health system might learn: They might learn that access to prenatal care is insufficient in certain parts of the county, for example, or that patients need better transportation assistance so they can get to their doctor.

"Our purpose isn't to point fingers," Kipp said. Rather, the goal is to identify what, if anything, went wrong and try to prevent it from happening again.

The committee summarizes its overall findings so it can seek trends. It distributes that information to health care providers and the public.

During 2001, for example, the committee reviewed 10 cases that included 11 babies. (One mother was pregnant with twins.) Here's part of what the committee found:

In all cases, the mothers had multiple medical conditions.

50 percent of the women were obese.

60 percent of the women had previous fetal loss; only one of the 10 women was pregnant for the first time.

30 percent of the women were 35 or older. The youngest woman was 22.

40 percent of the women used tobacco.

90 percent of the women were married.

Access to care, transportation, violence and neglect, lack of social support, poverty and culture were not identified as issues in those cases.

Kipp has a difficult job, particularly the task of interviewing the mothers. But she said the women generally are supportive and are eager to help any process that might prevent another mother from experiencing what they experienced.

Many find talking to Kipp is helpful as they grieve.

"Many of them do not go for any counseling or help," she said. Where appropriate, Kipp provides referrals for those kinds of services and others.

Kipp also said health care providers are cooperative.

"They're interested in making things better," she said.

"Fetal and infant mortality has long been considered a reflection of the social and economic well-being of a community as well as the state of health of its citizens," the committee's 2001 report stated.

"Reviewing these cases helps to determine trends in the health care and social assistance system that are occurring, and barriers to care that may need to be changed."

In other news:

NEW NURSES: If all goes as planned, the first of 24 specially recruited nurses from the Philippines will begin work at Citrus Memorial Hospital between September and the end of the year.

The hospital last year hired Nurses to U.S.A. Inc. to help recruit the nurses and bring them here. The company has provided similar help for the Shands hospital system and Munroe Regional Medical Center in Ocala. Those hospitals, like all hospitals, struggle with the statewide nursing shortage.

Julia Doucette, director of human resources at Citrus Memorial, was supposed to be part of a team visiting the Philippines to interview potential candidates. But the Sept. 16 trip was canceled because of the Sept. 11 terrorist attacks, and the interviews were completed by using video technology.

Doucette said the nurses are waiting to clear immigration. She said the nurses speak English and are educated at the bachelor's degree level based on American nursing school curriculum. Most also have professional experience.

-- Jim Ross writes about medical issues in Citrus County. Reach him at 860-7302 or

jross@sptimes.com.

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